Incident Report

  • For Internal Use Only

    All information should be noted immediately and not left to memory

    1. DO NOT admit fault regardless of the situation or circumstances

    2. DO NOT indicate that you are collecting information for insurance purposes

    3. DO take an adequate number of photographs to clearly document conditions present at the time of the incident.

  • (Note attitude of claimant, i.e., interest in name of insurance company, obvious impairments, age, etc.)
  • NameAddressPhone 
  • Name/Address/Phone#
  • NameAddressPhone 
  • NameBadge#DepartmentReport/File Case# 
    Please retain any copies of official reports and send to the Office
    Please send any photographs via email